International Development Committee
Oral evidence: The UK Government’s work on achieving SDG2: Zero Hunger, HC 112
Tuesday 30 January 2024
Ordered by the House of Commons to be published on 30 January 2024.
Members present: Sarah Champion (Chair); Chris Law; Nigel Mills; David Mundell.
Questions 1 - 54
Witnesses
I: Tariro Washaya, Programme Manager, MeDRA (Methodist Relief and Development Agency) Zimbabwe; and Victor Mughogho, Executive Director, Eagles Malawi.
II: Abigail Perry, Director of Nutrition, World Food Programme; and Florian Monnerie, Country Director, Action Against Hunger DRC.
III: Dr Mairo Mandara, Global Leadership Council Member, United Against Malnutrition and Hunger; and Grainne Moloney, Senior Nutrition Adviser, UNICEF.
Witnesses: Tariro Washaya and Victor Mughogho.
Chair: I would like to start this session, which is the beginning of a new inquiry that the International Development Committee is doing on nutrition, specifically looking at the Government’s work on achieving SDG2, which is zero hunger. We will have three separate panels today. In our first panel, we are looking specifically at local voices in malnutrition and hunger, and we are very fortunate to have Tariro and Victor here to talk to us. Could you begin by introducing yourselves and the organisations that you work for?
Tariro Washaya: Thank you so much, Sarah. Hello, everyone. My name is Tariro Washaya. I am with the Methodist Development and Relief Agency; in brief, we call it MeDRA. I am from Zimbabwe and we are a partner of All We Can. Thank you.
Victor Mughogho: Thank you very much, Sarah. My name is Victor Mughogho. I am the director of a local organisation in Malawi. We call it the Eagles Relief and Development Programme. It functions under a local church here, but it is an organisation that has been around for the past 20 years. Thank you very much.
Q1 Chair: Victor, what does Eagles do, when we are looking at nutrition and trying to prevent hunger?
Victor Mughogho: Interestingly enough, in terms of the genesis of Eagles, it was birthed out of a crisis in the nation of Malawi. There was a famine in the year 2002, where 5 million Malawians were facing starvation; they had no food at all and it was quite a big famine. That is the time Eagles came on the scene to try to work with communities to find solutions—how to come out of this severe and acute food insecurity that had hit and affected the nation. People were dying from hunger at that particular time. That is why the organisation was birthed. We have been trying to look for solutions since that time to the present moment.
Q2 Chair: What was the cause of the famine in 2002?
Victor Mughogho: We had drought in southern Africa—a severe drought, where you have crops that wither, wilt and die, and you have rivers also drying up at the same time. The reality is that in the past 20 to 30 years, these episodes of drought have been incessant and continuous. They have contributed to some of the crises that we have been facing. In 2002 in particular, the drought was quite protracted.
Q3 Chair: Tariro, the same question to you: what does your organisation do on the ground to help?
Tariro Washaya: The Methodist Development and Relief Agency is an arm of the Methodist Church in Zimbabwe. We come from the Wesleyan sector of Christianity. Through the Methodist Church, it was discovered that there is a need to support communities in issues of development and relief. As my colleague has said, in southern Africa around the period of 2002 we experienced an intense drought that affected communities. The Church saw that there was a need to have an arm that would support vulnerable and marginalised communities in issues that are related to poverty, food security and access to water.
From then, the Methodist Development and Relief Agency was formed in 2004, and it has been supporting communities with our vision to see a society in which all enjoy abundant life and God’s given dignity, which is informed by John 10:10. We have been supporting communities to create an empowered community that is not food insecure, which is economically well up and also that has access to basic services. MeDRA has been supporting communities from then until now, and it is being guided by the different global development goals and also ensuring that communities have access to food. We are trying to ensure that we achieve zero hunger in the communities and also trying to defeat the challenge of malnutrition. That is the brief about MeDRA. Thank you.
Chair: Thank you very much—an honourable ethos.
Q4 David Mundell: Can I ask you both, what are the challenges that your community is facing in terms of hunger, food insecurity and malnutrition?
Victor Mughogho: Communities are facing several challenges. Let me start with the grand one, if I may put it that way.
As a country, Malawi has a population of about 20 million people. Our children are facing severe malnutrition—for instance, stunting, which we all understand is when children are short for their age. It is a crisis in our country. In other words, there is no production of nutritious food that will help with child growth and child development.
In 2010, the percentage of our children facing stunting was 47%; that means almost one of every two children. It is a crisis because it leads to cognitive impairment. You have children who will be the leaders of tomorrow whose brain development is affected. They are the ones who will be the leaders. They are the ones who have to provide solutions to an entire nation, but what stunting means for them is that their upbringing—the very genesis of their lives—is compromised. Currently, it stands at around 37%. All I am trying to say is that we have this ongoing crisis where children are malnourished and stunting is affecting their development.
Another challenge is food insecurity overall. What is happening because of climate change is that we have been facing this drought, and then in the past four years, cyclones have also started coming in from the Indian ocean along the Madagascan route. These cyclones have hit Malawi about four times in four years. They have destroyed areas where crops are grown. Literally hundreds and thousands of hectares were washed away and they lost their livestock. Some farmers we work with in some of the districts would show you dead goats; one farmer had lost 17 in one go. Their houses are destroyed and crops are washed away. The impacts of climate change have become very current and very severe. The challenges in the food security situation are made worse over time.
I would also mention that Malawi, just like other countries in southern Africa, has faced the challenge of HIV and AIDS. Our prevalence used to be in the top 10 in the world—with over 1 million. You have the health challenges, where you have the productive population ending up losing their lives as well. These are some of the challenges that we do face: climate change, malnutrition, and food security compromised by our droughts and flooding as well.
Q5 David Mundell: Thank you. Tariro, could you answer this question in the same way? Victor pre-empted my next question by setting out what had caused the challenges, so could you set out what the challenges you face are and what you think the causes of those challenges are?
Tariro Washaya: I will start by mentioning that Zimbabwe has been the breadbasket of Africa for so many years, but unfortunately that has changed over time, causing communities or in general Zimbabweans to be food insecure. This challenge of food insecurity was mainly caused by the issue of climate change. I think this is now a global issue. Climate change is affecting the production of food all over the country. As my colleague has said, we have been experiencing floods and a different number of cyclones. In 2019 we experienced Cyclone Idai and from then the country has experienced a number of cyclones, and these have been negatively affecting the country’s food production.
The economic situation in Zimbabwe is very volatile now. We have a high inflation rate and this is affecting access to food for different communities, especially the most vulnerable and marginalised communities that live in the rural areas. With this hyper-inflation, people cannot afford to buy the food basics and this is causing food insecurity in the country.
Generally, because of this poor economic environment, communities do not have access to farming inputs because the communities in the rural areas live on agriculture, which is usually rain-fed agriculture. They do not have access to agricultural inputs because of the ever-increasing poverty rates in the country. With that, because of the poor soil fertility, they are not able to support their soils to have good production. This is affecting the production of food and the households become food insecure.
With climate change, there is poor adaptation by the communities and a lack of knowledge of these changes in the climate seasons. We used to receive our first rains in late October or November. This has affected the communities. Their knowledge is still very low. They are failing to adapt to the issues of climate change. With that, the production rate again is very much affected. The general causes of climate change are affecting the communities. They are no longer able to produce the food that they used to. With that, they are surviving on sometimes one meal a day. Sometimes there is not dietary diversity in the type of food consumption, which is now causing malnutrition, affecting the little children, the pregnant and lactating mothers, and in general the poor and elderly in the communities.
I will sum up by saying that with the effect of climate change and the lack of adaptation in the communities, they do not know that they are now supposed to be growing the small grains that need less water because we are receiving less water these days. Generally, these are the challenges that we are facing. The cause is mainly the effects of climate change and the volatile economic environment that Zimbabwe is in.
Q6 Chris Law: Good afternoon, Tariro. You were talking about the high inflation and volatility. Is part of the reason that there has been difficulty—and no longer being a breadbasket—what happened in the early 2000s with the farms, particularly white farmers, who I think were pushed off their farms? Has that had a knock-on impact and has there been any recovery since then?
Tariro Washaya: Yes, that is one other reason. I am sorry—I missed that one. Yes, the changes that happened because of the political situation in the country—the land reform—affected the production of different food varieties in the country. With that, the people who now own the land have little knowledge of agricultural production as it was in the past. Not only do they have little knowledge, but also they do not have the financial back-up for them to be able to procure the required farming inputs for them to be able to do irrigation farming and everything. That really affected the production rate of Zimbabwe.
Q7 David Mundell: It is interesting to hear about the challenges you have set out. What barriers are your community currently facing in overcoming those challenges?
Victor Mughogho: Communities in Malawi are facing several barriers and challenges. The very first one also relates to what Tariro has mentioned. Malawi is also facing quite severe and acute economic conditions. In November, the country’s currency was devalued by 44%. Immediately, within a night, prices of almost all basic commodities—including fertilisers—doubled. That was the time they were supposed to procure and plant. The majority of our farmers are subsistence farmers; 85% of the country are subsistence farmers, which also means that they have a very small landholding size, against a booming population, which over time means they are all squeezing into very tiny plots.
Deforestation is another crisis in our country. Basically, that means that there is massive soil erosion at the very same time, with loss of soil fertility. Regarding the deforestation that I have mentioned, it may please the honourable Members just to know that Malawi’s access to electricity is at about 10% to 12%, which means that about 80% of our nation has no access to electricity. That means that they all subsist on biomass—so deforestation becomes the order of the day, which impacts food security because then you are losing soil fertility. We then have rivers that start flooding very easily because of the siltation of the rivers. It becomes a vicious cycle.
There is a high cost of inputs because of our economic conditions. Obviously, the Government lost direct budgetary support over the last 10 years because of mismanagement issues. That changed in around November or December when the IMF programme started again, with the ECF. The inputs are unaffordable for the local farms. Their plot sizes are very small against a booming population. We have already mentioned the climate change. That is massive; basically 85% of the population are trying to grow their crops using rain-fed farming and then there is no rain. That means there is no food production. That is a big challenge. There are the droughts, and when the rains do come—we have mentioned the cyclones—it just makes a bad situation worse.
The other challenge is if you do not have electricity, you do not have access to information. Ideally, everyone should have access to the internet and be able to access information very easily, but with such severe and high levels of poverty, the majority cannot even afford a radio to listen to. I have just mentioned that these are some of the prevailing conditions that the people are facing on the ground. Of course, we do try to bring in some interventions, which we can talk about as we proceed. That is what I would say for now.
David Mundell: That is very helpful. Tariro.?
Tariro Washaya: Now I might end up saying the same things that Victor has said, possibly because we are on the southern African side of the continent and the effects of the barriers are much the same. I will start by mentioning the lack of knowledge. Generally, communities, as I mentioned earlier, do not have knowledge, especially about climate change and the effects of climate change. They still live with the old ways that they are used to, so that is a big barrier that is affecting the general communities, especially those who are in the rural areas. They do not have anyone to teach them unless the development partners come in to do some training. Yes, we have extension workers from the Government side, but they cover a big population, such that the adoption or the adaptation by the different communities is taking time.
The lack of knowledge and the economic environment of the country generally are big barriers. Some people might not have knowledge that instead of planting the usual maize grain that they used to in the past, they are now supposed to be adapting to the early maturity grains or the short season variety grains—those types. They cannot afford to buy the inputs for them to be able to grow the maize, and also they do not have money to buy the inputs, like the fertilisers, for them to be able to support the poor soil fertility. That affects the yield that they get.
Another barrier is post-harvest handling. In cases where they have managed to harvest, they are not able to handle their grains or their yield very well—because of, again, lack of knowledge or lack of money to buy pesticides that can help them preserve their grains. It is mainly the lack of knowledge and the poor economic environment that is a big barrier.
David Mundell: Thank you. That is a very important point—that more yield is possible, but it is because of these barriers that that is not being achieved.
Chair: Both Victor and Tariro, thank you for the evidence you are giving us so far. You are painting a very bleak picture, but you are giving us very good evidence about what the problem is, so thank you for that.
Q8 Chris Law: Victor and Tariro, you have touched already on, for example, lack of access to energy as well as the impact of the cyclones more or less every year in the last four years. What do your communities need to improve food security and access to nutritious diets? Tariro, let’s start with you.
Tariro Washaya: Generally, as I have said, the communities do not have knowledge. Good support for training and teaching communities to have improved knowledge and to know that they should adapt to climate change is one big need where we can support them, and we are supporting the communities with that right now. Also, we are supporting the communities with inputs, but this is very limited—not to everyone. We have selection criteria so that if they get different varieties of grain that adapt, and can manage in these different climatic conditions caused by climate change, they will have a better harvest and food security.
We need to continue to support communities with inputs in terms not only of seeds but of fertilisers. If only we could manage to mechanise again their type of farming, such that they get the different machines, that could help them again to have better harvests. Mainly those are the greatest needs that we see in the communities.
Victor Mughogho: In terms of nutrition, it is indeed a big need—a need that needs to be addressed yesterday, especially with the background that I shared. If you focus on what future generations will look like, if we do not address nutrition, and the stunting issues we have in our country, then the future is even bleaker and more desperate than it is at the moment.
What can we do to help boost the nutrition of diets at household level and community level? First, in the light of drought and the impacts of climate change, the promotion of irrigation farming comes to mind. We are running some of these programmes—solar-powered irrigation schemes, where we have been working with communities to establish the use of solar pumps that are easier and more cost-effective for the farmers. The idea is not being limited to rain-fed farming with our agriculture, which in Malawi is only three months. That leaves the other nine months of basically unproductive time and farm productivity goes down. If we can have irrigation throughout the year using various irrigation techniques, it would boost the food security status, and in so doing, allow families, households and communities to grow more food for their children.
You may also be interested to know that when there are higher levels of food insecurity, students start dropping out of school because their families cannot afford it. Sometimes they even use their children to help do piecework to raise money for their household. Irrigation farming is one of those options. As Tariro said, adaptation to modern farming techniques is critical, and education as well. Nutritional education also is very much needed. Other foods are available, but the communities need to be taught how they can combine different foodstuffs and create nutritious portions for their children.
The other thing that can help is simply maximising the available land. As I said, that also means education coming in and extension services. Overall, whatever farming methods we bring in, obviously the inputs question comes in, so you either subsidise the inputs or they cannot afford them. The other intervention that we have been trying to bring in ourselves is social protection. We have been doing cash transfer programming, if we have donor partners who can help us, so that we give cash to vulnerable households and they are able now to buy their food as well as buy the inputs and therefore boost their food security.
There are also interventions around village savings and loans—community-based and managed micro-finance, as it were. It is helping them to save a little bit of money and start small-scale businesses. Overall, what I see is if you boost the household economic status as well as the national economic status, if more people come out of poverty and they can have more disposable income, they can spend more of that on their children and buy more food for their children. That is what I would say for now.
Q9 Nigel Mills: Part of the job of this Committee is to scrutinise how the Government spends overseas aid money. Have you tried to access foreign aid? If so, how successful have you been? Victor, do you want to start?
Victor Mughogho: On overseas aid, I would say that as an organisation, Eagles Relief and Development Programme has been privileged once in a while to have access to funding from the British Government. In those days, we used to call that UK aid. We have had some programmes that were financed by the British Government. We were working in consortiums with other implementers. That made a massive difference. I mentioned the flooding issue we have in one of the districts, where we even have the sign of British UK aid because the whole community was about to be washed away by a river that had diverted its course, and we managed to do high-level flood mitigation, bring in an excavator and then communities planted trees—afforestation—and managed to redirect the river back to its original course. That kind of fund does make a difference.
Direct application has been a challenge. We had a partner in the UK who helped us to access funding with UK aid. Unfortunately, our proposal did not go through. Maybe local partners like ourselves just need a bit more capacity building on how we can access that kind of funding.
I think more of a negative turn in the funding landscape with the British Government was that soon after Brexit, I think there was a cut in foreign aid for a number of countries and Malawi was one of the affected ones. That came at the wrong time, if I may say so. It meant that the house was on fire but you are told that the fire engine is not coming to your house; it is going to prioritise another house in another location. We had an ongoing programme by that time but they had to stop all implementation. This was at the time when the cyclones started coming in. Malawi never used to have cyclones. This is the very first time it happened.
What I am trying to say is that this was at the time of greatest need. I am aware of the challenges the British also are facing but I would say that any help that came before that made a massive difference. That cut in support for countries as vulnerable as we are talking about here—Malawi and Zimbabwe—really put pressure on local communities. When we talk about zero hunger, we are talking about leaving no one behind. That is the challenge I face because I am still with these communities and I see how desperate they are becoming. Any help that can come would help us on the ground to build capacity and strengthen governance structures in the Government so that aid is better used, and then it can make a big difference.
In the first 10 years, there were instances of UK aid. I am also pleased to mention that even the British Commissioner for Malawi did manage to visit our communities. We took him around, and we showed him our irrigation schemes, he saw a village savings and loans group and he was impressed, which tells that you that it does make a difference when it is there. When it was cut, it also had a very negative impact on our landscape.
Tariro Washaya: As for MeDRA, I would not say that we have accessed directly foreign aid from the UK. We are getting the funds through our partner, All We Can, which has managed to help us to get here. From other countries—not focusing on the UK only—we get support from Germany and also from the Australian Government. As MeDRA, we are partners with one organisation from Australia and one organisation from Germany. With that, we have been getting support from foreign aid. However, for us to apply directly has been a challenge. We once tried when it was still DfID—we tried twice—but unfortunately we could not.
The other big organisations here in Zimbabwe used to get this funding from the UK aid. Unfortunately, as MeDRA, we are still a local small organisation, which is growing, and to fight with these big brothers in this field has proved a challenge. Instead, we try our best to form consortia, as Victor said. Usually when we form a consortium with a big organisation—possibly I will talk of CARE International, World Vision and Plan International. with those you do get the funding, but I will confess that, as MeDRA, we have not managed to get funding from the UK directly.
Q10 Nigel Mills: Finally from me, Victor—if you could choose an international aid partner, would it still be Britain or would you find somebody else more reliable that you would be more confident working with now?
Victor Mughogho: That is a tricky question, but a good question. I would say THAT the British Government have been a partner of Malawi for ages—scholarships, education and everything. A lot of them come to the UK and have their capacities built there. That has been consistent over the years—
Q11 Chair: Oh, no—Victor’s line has frozen. Tariro, could we ask you the same question? Would you be able to go to other countries for the funding or is the UK your preferred partner?
Tariro Washaya: I would say the UK is our preferred partner because of the support that we are getting with All We Can. I like the partnership that we have. I call the partnership working together, because they do not treat us as a big brother and small sister;they work with us, ensuring that the vision and strategy of MeDRA is achieved and we continue to support the vulnerable and the marginalised communities. I appreciate the support and I would go for the support from the British Government.
Q12 Chair: Tariro, if I could just push you a little bit, you said it was tricky to get money from the UK Government. Is that because policies have changed or just the amount of money they have is reduced?
Tariro Washaya: Unfortunately, we did not get the feedback of why our proposals could not go through. We tried twice, in 2017 and 2018, but unfortunately our proposals kept on bouncing. We did not get the actual feedback on where we failed or the reason we could not get the funding.
Chair: That is very unfortunate to hear. Yes, I don’t know the answer to that either, but the work that you are doing and the work that Victor is doing sounds extraordinary and so vital. Thank you so much for giving us your time today. As I have said, you have painted a pretty bleak picture but I think you have been very clear to us about what the issues are, and hopefully we can look at making suggestions on ways that the UK could step up and address some of those serious failings that are going on at the moment. Thank you both for the work that you are doing and for making the time today. Please do keep in touch. Your projects just sound so vital and so important. Thank you both very much.
Victor Mughogho: Thank you.
Tariro Washaya: Thank you so much for the opportunity.
Examination of witnesses
Abigail Perry and Florian Monnerie.
Q13 Chair: I would now like to turn to our second panel. We have Abigail Perry, who is Director of Nutrition at the World Food Programme, and Florian Monnerie—I am sorry, Florian, I have pronounced both parts of your names dreadfully, so hopefully you can correct me on that—who is the Country Director for Action Against Hunger in the DRC. I wonder if both of you could start just by telling me a little bit about your organisations. Florian, could I start with you?
Florian Monnerie: Action Against Hunger is an international NGO. As you know, we are a global leader in prevention and in providing assistance for life-threatening hunger around the world. To give you an idea, in 2022 Action Against Hunger provided assistance to 20 million people across 55 countries. Currently, we are also advocating and pushing globally for working on the drivers of hunger, whether they are climate change, conflict, gender inequality or poverty. For the DR Congo, we provide assistance. We have been there for about 15 years and we provide assistance to between 700,000 and 900,000 people affected by hunger and malnutrition every year across the country.
Q14 Chair: Florian, could I ask what might seem a silly question—why is tackling hunger and malnutrition so important for achieving the wider development goals?
Florian Monnerie: That would be exactly what the previous panel responded to. The effects of malnutrition or under-nutrition are a lifetime challenge for people who are affected, so you need tackle it early, in the first 1,000 days of the life of a child—from conception to two years—or you might tackle it within five years. Hunger will have a lot of impact on development—physical and mental—and that is extremely important and something that follows you. The mental health impacts of hunger—for example, for a mother who cannot feed her children because of conflict, and social and economic pressure—are very intense and affect an entire community.
Q15 Chair: Thank you. Abigail, tell us a little bit about your role within the World Food Programme.
Abigail Perry: Thanks, Sarah. I am the director of the nutrition division at the World Food Programme. We provide strategic oversight and direction for the World Food Programme’s work to address malnutrition and to ensure that the support we provide to ensure household food security also delivers benefits for the nutrition of vulnerable women and children. As I am sure you are aware, WFP is the largest humanitarian organisation in the world. Last year we reached just over 28 million pregnant and breastfeeding women and girls, and young children, with direct nutrition support, with a particular focus on reaching people in the most fragile contexts around the world.
Q16 Chair: Thank you. Abigail, the Government have produced their White Paper on development. Does it go far enough in terms of what you would want to see when it comes to nutrition?
Abigail Perry: There are many very positive aspects of the White Paper and we particularly welcome the renewed focus on ending extreme poverty and more broadly on the sustainable development goals, noting comments from earlier panellists on the important role of poverty as a key driver of malnutrition. I think there are some areas where the White Paper could have gone further in terms of maximising how UK aid and diplomatic power can be used to support improved nutrition. While there is reference through the White Paper to the importance of reaching those who are furthest behind, and indeed to improving nutrition, there are opportunities to ensure that FCDO and UK aid can deliver more meaningful benefits for the diets of the most vulnerable populations.
For example, ensuring that improving the diets of the most vulnerable populations is a clear objective for the work on climate, agriculture and across other dimensions of the White Paper would give that opportunity to optimise impact. I raise this because these are areas where there can be some tension. The focus on economic growth, economic transformation and job creation is extremely important and very positive, but those things do not always translate into either improvement for the population who have been left furthest behind or indeed ensure that people can access healthier, more nutritious foods.
At the moment, 85% of people across the African continent cannot afford a healthy diet, but unfortunately, availability of healthy foods is also a major barrier. There is a very big opportunity for the Government to be able to tie together their ambitions, investments and focus in a much more coherent way by looking at who will benefit and ensuring that those who have been left furthest behind are the primary focus, but also ensuring that some of these more difficult outcomes to ensure people can access nutritious diets can be achieved.
Q17 Chair: I understood everything you have said. We are a reasonably small country but we try to punch above our weight. What about in practical terms? You said you want to see more about our diplomatic reach in this area. In practice, what would that look like? Would it look like our ambassadors talking to Governments about their priorities? Is that what you mean?
Abigail Perry: Yes, I think both at the country level but also through global initiatives. We still do not see enough voices to ensure that action investments in areas such as climate and economic growth do deliver benefits to people’s nutrition. There is an area that the UN has been trying to give much greater visibility to through things such as the UN Food System Summit and the Stocktaking Moment, and even through the COP process as well. I think this is an area where the UK has the potential to influence and engage those processes, so that the idea of access to nutritious diets is understood as being a function and role of multiple different sectors, not just the nutritionists.
Chair: Are you not seeing that in the White Paper or on the ground?
Abigail Perry: No. It is implied in chapter 7, but it has not read across in the other chapters of the White Paper—the problem being that if you do not explicitly reference that as a goal, there are many other competing priorities or competing objectives. But we know, including through work that has been done in the UK context domestically, that there are opportunities to try to strive for some win-wins, recognising that access to more nutritious, healthy diets brings so many multiple benefits, including ultimately more resilient and economically prosperous societies in the longer term.
Q18 Chair: Florian, what are your thoughts on this? What more could the UK be doing?
Florian Monnerie: Thank you very much for that. I would first reinforce what my colleague from WFP just said because they would have been my talking points as well. What more on the White Paper? I would say the first issue is that there are a lot of opportunities for economic growth and this is very much outlined in the White Paper. Unfortunately, there is a lot of immediate need that needs to be tackled on the ground. We are talking about 100 million people who suffer malnutrition and under-nutrition and are in direct need of assistance, so finding this balance between what is an emergency programme and what is a development programme—all of them working together—is quite important to underline, not only in the White Paper but in the approach.
I would also say that leaving no one behind is something that I particularly welcome—looking into everything that can be transformative in society that could tackle malnutrition from the start. Even in the emergency programme in the DR Congo, we have an epidemic of gender-based violence, and especially sexual violence, whether in a conflict or in society. That does have a tremendous impact on malnutrition and on small children as well with their mothers being affected by GBV, so I would definitely outline those two points.
Q19 Nigel Mills: Abigail, I think you were still in the Department when we produced the nutrition strategy in 2017. Has that worked as well as you thought it would? Do you wish, if you had known then what you know now, that you had done something different or was it a pretty good piece of work?
Abigail Perry: Yes—full disclosure, I led the writing and the development of the strategy, so I realise I have a little bit of bias on that. I think the kind of relevance and resonance of the strategy still broadly hang together. I do think that there are a couple of areas that undoubtedly would need to be looked at again and strengthened for a new strategy or for an updated strategy. There have obviously been some important shifts in the global narrative and thinking around food systems and climate, and the interactions between them in terms of how they affect access to healthy and nutritious foods and the challenges and opportunities they present. A greater reflection on that would also enable the UK to talk more clearly about how it can bring together areas such as the research and development in climate-resilient crops, some of these cross-cutting investments around climate and agriculture and so on, and to talk about how they can more meaningfully strengthen food systems in a very climate vulnerable world.
Another area that certainly needs more strengthening is to do with the focus on populations that are being left behind and that sense of the importance of dealing with inequalities. I do not think that was as strong as it could be. Certainly, I think when it comes to achieving equitable improvements, we do need to give much more focus to populations that, as I said, are being left behind.
The final thing to reflect on is the question about the accountability for driving results and progress on that strategy. Malnutrition and improving diets, as panellists have said so far, is such a multi-factoral issue. It relies on action across multiple different areas and I do think that there has to be the right level of accountability across FCDO for delivering on a strategy like that. I think often it is seen too much as the responsibility of a single team rather than recognising that it is the responsibility of the Department more broadly. That is about trying to optimise the contribution ODA can make because getting those synergies and harnessing the complementarity of funding is where we get to see very concrete results.
Q20 Nigel Mills: Do you think the strategy worked? Has it made a difference or is it just a well-written document that has gathered dust and has not changed anything?
Abigail Perry: Again, I feel a little bit biased in terms of being able to reflect on that. I think the ICAI review that was done in 2020 gave a very positive assessment in terms of actual progress on the ground in supporting Government-led systems delivering direct benefits for populations in need. I did feel at the point at which I moved out of FCDO that there was a meaningful shift in the way that nutrition was being prioritised and understood across the Department and the way in which opportunities to improve nutrition were being taken forward. Again, I recognise my own bias on this one. I feel like it did provide a helpful framing, alongside the Government’s manifesto commitment in 2015 to drive a concerted effort around programming in approaches to nutrition.
The world is a pretty complicated place and has been even more complicated since that point, so the question of sustained impact is the one that is always much trickier. I think the combination of covid, the global food crisis, the cost of living crisis and the question of the legacy, is a little bit trickier of course, and there has been a lot that has happened since then—but I think broadly speaking it was an actionable and useful document.
Q21 Nigel Mills: Thank you. Florian, you wanted to come in. Are you going to tell us it was a terrible strategy and Abigail got it all wrong, or are you going to be a bit more positive than that?
Florian Monnerie: No, absolutely not. I wanted to share an experience because Action Against Hunger in DRC received funding from FCDO before 2017 and it went through from 2017 until 2023. We were implementing the strategy on the ground. There is one thing I would like to say first. Talking to beneficiaries today, they still remember the FCDO programme Action Against Hunger was implementing, so this is something they talk about—namely DfID or FCDO, depending on the time the programme was implemented—especially in the west of the country.
There are specific things I can underline. For example, in implementing aid and implementing it broadly with a comprehensive integrated approach, there was nutrition and health, and especially sexual and reproductive health. A lot of women underline their having been able to get support for giving birth in the health centres, where they usually would have to pay and would not be able to pay. Receiving information on contraceptives to be able to control the number of children in their family and reduce the pressure on their household to find more food is something that we welcomed.
I talked to a woman who remembers seeing that, through FCDO programmes it was the fact that they would be community-led interventions that would help identify children, especially in areas of conflict, and help them access what they need. That is something that was most welcome for us. FCDO has been for a long time a very important partner in the DR Congo and across the world, obviously. Over the course of 10 years of funding with FCDO, we managed to reach out to millions of people with free healthcare and nutrition. Hundreds of thousands of children have been directly saved through interventions funded by FCDO, and the community remembers this.
The funding cuts have particularly touched the DR Congo programme on nutrition. Today these funding cuts are impacting on the ground because there were a lot of places where only FCDO would fund partners to go outside of the conflict zone that currently do not receive funding for either emergency nutrition programmes or long-term nutrition programmes.
Q22 Nigel Mills: Thank you. Abigail, you mentioned accountability. Is there a collection of measures or performance indicators that we could use to see how successful we are being in tackling this or is the world a little bit too difficult to have any easy measures like that?
Abigail Perry: It is a pretty sensible starting point in the commitments that the Government have made to report on the OECD DAC policy marker, but I think probably there is a need to push a little bit further on from that. There are metrics along the theories of change of how investments the UK is making are progressing and we need to look at the ability to aggregate information about how results are being achieved in terms of improving access to nutritious diets and improving nutritious outcomes.
This comes back to my earlier comment about ensuring that there is clarity on the question of the kind of people that need to be reached and the kind of changes that we want to see, and the extent to which there is the feasibility of pushing that little bit further in terms of stress-testing whether or not initiatives and programmes are being designed with that in mind and making sure that there is some ability to track whether those principles are in place. That should be wrapped into how the policy marker is applied, but typically I think there is still a bit of a need to push that a little bit further forward.
There was some very helpful learning that came out also through the ICAI review that was done on looking at some of the measures of more system change and the way that UK funding can leverage bigger impacts, which I think may also form some quite useful basis for thinking through ways of being able to better track not just the direct results achieved through UK aid funding on nutrition, but also these broader shifts in systems capacities and what that means for sustained impact over time.
You are right, it is not a particularly straightforward thing to do, but I think some of the principles that certainly DfID into FCDO followed around results frameworks or logframes and the way of thinking through theories of changed. There are some areas where you could look more concretely at aggregatable measures of progress across these different types of investments.
Q23 David Mundell: Abigail, in your wide experience, what does a good nutrition programme look like?
Abigail Perry: That is a very big question. Obviously, there are certain interventions that we have for which there is a very strong evidence base. I think my colleague, Grainne Moloney from UNICEF, will also talk more later about some of the more specific interventions. From the perspective we are looking at from the World Food Programme, often what we are trying to do is look at how to address the very context-specific causes of malnutrition. That requires a much more complex way of looking at how we design and consider programmes.
There are three dimensions when it comes to the best practice for looking at nutrition integration and the design of programmes. The first one is to ensure that there is a really good understanding of who is most at risk of malnutrition or affected by malnutrition, and why. Again, we use a variety of tools such as looking at the cost of a nutritious diet, looking at market functionality—what is available for people to buy—as a way of trying to better understand the nature of the problem. Then obviously ensuring that programmes are designed specifically to try to address and bring together the kind of action that you need to take to address those key issues is very fundamental, but in doing that, it is important to ensure that we are looking at the kind of scale and sustainability of initiatives. I think that nutrition, like other areas, has been littered with a number of boutique projects that are trying to improve nutrition, but where ultimately it is very difficult to imagine how they can go to scale or how they can be sustained in the longer run.
Finally, because of the complexity of trying to ensure that programmes are adapted to or appropriate for the local context, I think there has to be a much greater focus on monitoring and learning through these kinds of initiatives so that we can properly understand whether the assumptions we are making about the changes we expect to see, and whether we are reaching the right people, are being properly documented and tracked. Again, because of the complex factors that drive malnutrition in many contexts, without continuous monitoring learning and reflection on how we strengthen our approaches, there is always a risk that we end up going down the wrong road when it comes to the strategies that will achieve impact.
Q24 David Mundell: I will just follow up on that and then I will come to Florian, who I saw was indicating that he wanted to speak. Following up on what you were saying, how do you think the FCDO can ensure that the programming is responsive to local needs and to the issues on the ground, and work more closely with locally based organisations?
Abigail Perry: Again, I am very conscious of some of the comments that were made by the first panellists about some of the challenges around ensuring that perspectives are being taken on board and that funding is being shaped by the perspectives of local actors. I think that there is a real need to ensure that there is an investment: as I said, in this analysis to understand the problem at hand and to undertake those consultation engagements with local partners and local communities, as far as possible within design processes; and to ensure that the mechanisms are in place and partners are adhering to the mechanisms in place, to ensure that there is accountability to those populations, and that feedback can be sought and enacted upon to ensure that these kinds of adaptions to programmes are fit for purpose as those programmes progress.
David Mundell: Florian?
Florian Monnerie: Yes, I will complement on both questions. I would say that for Action Against Hunger a good nutrition programme is an integrated programme that looks at a whole-of-system approach but also looks at how to respond effectively. To give a concrete example, a nutrition programme obviously has a health component. In the DR Congo, for example, we have understood that people tend not to go to health centres, if health is too expensive, for nutrition or otherwise. Providing not only nutrition but free healthcare in the same centre at the same time, supporting the health centre from the Government and supplementing them is very important, but so is looking into mental health, sexual and reproductive health, providing water and hygiene in the centre and in the communities that are affected, and, finally, working especially at community base level, with the community that us affected for identification and referral of nutrition issues but also working with local grassroots actors.
For us, in the DR Congo, we are working more and more with grassroots actors to provide specific parts of the nutrition programme, not the one that would be provided by the health centres, but the one around, for example, explaining how to have a diverse diet, but also how to have eco-agricultural projects. These eco-agricultural projects would be looking into diversifying the types of seeds that are being planted and how they can grow in different places of the DRC in the same way.
We are also looking into localising mental health, working with universities in order to have a curriculum that takes into account what it means for mental health in emergencies and especially for nutrition but as well, working with local partners that provide niche mental health support, usually in languages that international staff do not speak, and that helps push the nutrition and the transformative aspect that I would expect.
Finally, we would definitely look into gender inequalities and work with local partners on these gender inequalities and how we can better share messages and better share programmes around this to have a long-lasting impact outside of just providing direct assistance.
Q25 Chair: Abigail, do you agree that the interventions that Florian listed are those that would make the biggest difference?
Abigail Perry: Obviously, there can be contextual variations in what is driving malnutrition, so I certainly do not disagree with the key building blocks.
What I wanted to raise is a little bit about the question of entry points on this. My experience of when it is more a Government-led approach and looking at Government systems in the longer run is that it can be quite overwhelming, I think, for Governments to try and take on very, very complex multi-sectoral, multi-systems approaches. I think this is where FCDO in its engagement with Governments can play a key role in breaking that down a little bit to ensure that the ways that you can strengthen systems and policies under different line ministries, and ensure that they still add up to an approach that will benefit the most vulnerable people. At the heart of that is making sure that there is a common or clear understanding, or an agreed understanding, of who is most vulnerable and why, and working with the different ministerial sections at the ministries of the Government to look at the concrete ways that they can play that role.
In my experience, it can suddenly become such a very complex set of things to try to pull together and, as I am sure you can appreciate, Governments around the world working in a cross-ministerial way can be very complex. The scaling up nutrition movement has been fundamental in trying to support Governments on that, but I think we have to be quite practical about the fact that it is still not an easy way of working for Governments. So I agree that those components are often particularly key, but I think when it comes to the question of how to make that happen in a sustained way, we still have to, for want of a better phrase, break the elephant down a little bit to enable Governments to take forward actionable approaches that feel doable within the way that Government structures work, while still achieving concrete benefits to the people who most need to be reached.
Q26 David Mundell: Do you think that right now UK Government aid is getting to the most vulnerable—or does something need to be done to bring more focus on that?
Abigail Perry: Fundamentally, the elephant in the room is the degree to which ODA is being used to cover the cost of refugees in the UK—at this point in time, the share of ODA going to the most fragile, vulnerable populations and so on. Clearly, both the level and orientation of focus of funding is not fully in line with the idea of ensuring it is reaching the most vulnerable populations. I find that the FCDO is very definitely open to proper discussion about understanding who is most vulnerable to ensuring that decision making around the prioritisation of aid is cognisant of or considerate of how to ensure populations that are most at risk can be reached.
The level of core funding that has been provided for the UK to WFP—it is not the same for other organisations, I am sure—has remained fairly steady and that allows us the flexibility to address the more neglected crises and ensure that we are able to deal with contexts that are chronically underfunded, unfortunately—places such as Sudan, for example, remain chronically underfunded.
What is happening in earnest across the entirety of ODA spend is a bit of a mixed picture.
Q27 David Mundell: Now that you are on the other side of this fence, so to speak, can you identify any FCDO processes that could be improved to ease the burden on delivery partners like yourselves in accessing UK assistance?
Abigail Perry: Can I pass that question to Florian first? I am conscious that we are funded in quite a particular way and I think Florian probably has more interesting insights on that one than I do. I will be happy to add comments afterwards.
Florian Monnerie: Yes, I will take that one, gladly.
When we are talking about a country like the DR Congo that has both an emergency—a crisis or a conflict—and chronic malnutrition due to the driving factors we have talked about, a lot of actors would be willing to come in and help. There are grassroots actors, or national NGOs such as those in the first panel. Some of the FCDO funding modalities and flexibilities—for example, the commercial contracts—do not speak well to the civil society and the national NGOs. We have seen more and more commercial contracts that, for the purpose of working on malnutrition, would not be very helpful.
Secondly, especially if you want to commit in an area for a specific amount of time—one year, two years—with support to the local governments and the national Governments, there is a need for predictability of funds and sometimes, some of these activities start, whether for Action Against Hunger or whether for these local partners we work with or that work directly, and when they have to negotiate their budget and spend some time discussing it, the funding cycle runs through. It does not always start at the end of one project and go on to another. It says 18 months, but ultimately the money is only good for 12 months. That does bring a lot of pressure to the partners on both cycle development—the time it takes to develop a project, which would be a one-year, two-year or three-year project—and also how to bring this civil society grassroots organisation, national organisation and sometimes the Government inside these projects to be sure they would go.
Finally, I would say the payments by results, especially in nutrition, can be complex. It definitely can be complex when there are shocks and crises that intervene during the projects. These are the things I would like to underline in answering your question on the processes and how they would work moving forward.
Q28 David Mundell: Thank you. Abigail, did you have anything further to reflect?
Abigail Perry: The UK is a member of WFP and is represented on the executive board. We very much appreciate the engagement and negotiation to ensure that funding relationships and associated reporting can be as smooth as possible. We are in a very different position when it comes to how the UK funds us in our function as a UN agency.
I would like to reiterate comments that Florian made about the predictability of funding. It is not so much about the processes, but rather the sense of the UK having become a much less predictable actor. For the work that WFP does in more acute crises, there is a lot of advanced planning that we can and should and need to do to gain efficiency in how we operate.
Unpredictability in funding decisions or unpredictability in fluctuations can make it incredibly difficult to ensure that can get things such as specialised nutritious foods to our partners and communities on the ground as efficiently and effectively as possible. That the kind of unpredictability in approach can be extraordinarily difficult. In the past, the DfID was really quite progressive when it came to also looking at multi-year and very flexible funding for these very difficult contexts. Again, I do not think it is a function of processes per se within FCDO, but rather, reflects a little bit some of the broader aspects policy environment that FCDO has been under. However, I think the lack of flexibility in funding and the multi-year nature of funding in these more challenging contexts, has also made it a lot more difficult for us to get to the crux of trying to stop crises before they start, or at least to try to ensure that crises do not end up as bad as they are, while recognising that the UK was really quite progressive in this area compared to other humanitarian donors so we very definitely—
Chair: Abigail, could I pause you there because we trying to do some more forward facing if that is okay.
Q29 Chris Law: You have answered part of my next question, but I do want to ask a little bit about the impact of the cuts. I have just been looking at them. In 2021, you had 65% cut in nutrition programmes in sub-Saharan Africa, a 61.3% cut across malnutrition and if I look more broadly at nutrition spending, even in the last year, almost half has been cut. What impact has that had and to what extent do the cuts impact what the UK Government is trying to do in playing its part in efforts to prevent and tackle global malnutrition?
Abigail Perry: The World Food Programme itself does not, or has not historically received, development nutrition funding from the UK, but has benefited significantly from the humanitarian funding that supports a lot of nutrition activities. The cuts more broadly to humanitarian funding, including as a result of the UK’s drops, are putting us in an incredibly difficult situation in the context we are working in. For example, the cuts in Afghanistan have meant that around 1.4 million pregnant and breastfeeding women and girls, and young children, can no longer the specialised nutritious foods and support they need. Data and analysis is showing a very concrete increase in the numbers of children being admitted for treatment for severe wasting. That is not a unique or only UK funding scenario, but illustrates that there we see some very concrete impacts.
My broader reflection on the cuts to development nutrition funding: it has to be put in the context that several years ago the World Bank assessed what investment was needed for us to be able to scale cost-effective nutrition interventions in order to achieve World Health Assembly and SDG targets on nutrition, and the donor share of that was already very far off track. At that point in time, the UK was by far the biggest development nutrition donor so we have seen this significant cut come down from the UK.
We have seen some increases but primarily from the Bill & Melinda Gates Foundation, which is a very important actor in this space but funds and operates in a very different way from the way that the FCDO would fund. Concretely what that means is less resource to ensure key services to address malnutrition and support progress. There is less resource for that so undoubtedly there are tangible impacts on coverage and the quality of services on the ground.
Q30 Chris Law: Thank you. Florian, what about your experience with your own organisation? How adversely impacted were you by the FCDO cuts?
Florian Monnerie: Action Against Hunger has been a long-term implementing partner of FCDO and DfID prior to that. Since 2019, Action Against Hunger worldwide has lost between 40% and 50% of the funds that you used to provide so that significant gap has obviously impacted the programmes.
I will take three examples. We have programmes in Somalia, Nigeria and DR Congo, where we had thought the programme across several years could increase the impact of our action and support national actors including governmental actors in the way we were doing, and these three programmes have been cut two years into a programme that was a three-year or four-year thinking. That affected effectively how we would reach out to people who were facing malnutrition or under-nutrition. That has been quite difficult because we were faced with an issue and there were these cuts. Do we go for life-saving only? That is usually what we do, but if we go with only life-saving assistance with the funds that remain, we do not tackle the underlying causes, and then after six months or a year, or two years, you will come back with the same type of malnutrition, when there is a new economic or natural shock that affects the same population. If we tend to just go back to this life-saving and these types of cuts, we will not create the transformative action we start with long-term programmes.
Q31 Chris Law: I guess it is a shout out to you both that the FCDO’s overall ODA budgets are planned to increase in the next financial year. To both of you, how would you like to see it spend its money?
Florian Monnerie: We had a programme with the FCDO here in the DR Congo. It is covering the whole country, not only the crisis affected part of the country in the east, where malnutrition is chronic and where there are a lot of needs. If there is an increase in funding—and we can ask—we will look into making sure programmes will be based not on the geographical need, but on vulnerability in the entirety of the country, especially in areas that are not covered by other nutrition partners and where we can continue building our work with national NGOs to be sure that with Government and national NGOs there is a continuity across nutrition programmes in the DR Congo.
Q32 Chris Law: How can the UK Government be accountable to donors and the people their programmes are designed to support? I guess the obvious first one would be not to cut programmes mid-stream, but what about any other thoughts you may have?
Abigail Perry: I will go back to comments I made earlier about ensuring predictability in funding decisions and clarity in terms of what is going to be invested in and following through on that. It is also about ensuring that there is a strong focus on being able to demonstrate that support is being prioritised and targeted to, and reaching, people who are most vulnerable. Given the particular focus on ending extreme poverty, I think being able to demonstrate and report on the fact that aid is being prioritised to the right people at the right time is also a key part of ensuring trust and accountability, to both the people who are being served through UK aid and to taxpayers.
Q33 Chris Law: Florian, how would you like to see the UK become a more dependable partner that you can trust?
Florian Monnerie: That would not only be through funding; I would definitely say that.
Funding and predictability of funding are important. I would also like to see continued investment from the UK on nutrition, both globally and in the countries that the UK is committed to, and see a strengthened and reinforced commitment for, for example, the Nutrition For Growth conference that is coming in and making pledges that would accompany the compact on nutrition. These are the things that Action Against Hunger would expect from the UK and at a local level, maybe on accountability—working with, and asking for the partners to work more, with local and grassroots NGOs, and make sure that the work that is being funded by the UK goes beyond one or two grants, and provide transformative change in the society to reduce malnutrition over time.
Q34 Chris Law: Thank you. Your question leads into a question for Abigail about more local support.
What role do women smallholder farmers play in supporting local food needs and does the FCDO do enough to support those farmers?
Abigail Perry: It is a very good question. Very clearly, women are disproportionately affected by malnutrition and hunger and despite the fact that they are responsible for producing about 50% the food in the world, only own a very small share of land—I think something like 15%.
Q35 Chair: Abigail, why are they disproportionately impacted by nutritional shortages?
Abigail Perry: First, women have higher nutritional needs during pregnancy and breastfeeding, which means that their risk of facing malnutrition at that time is higher, very simply because they need to access the right kind of nutrition at that point because of their increased physiological needs, and that also includes through adolescence. Gender inequalities in many countries mean that women’s agency, choice and control over what they get to eat and, indeed, access to broader services that can help protect and ensure their nutrition can also be extremely limited. Around 60% of people facing chronic hunger are women and girls, because of both the physiological challenges but also the issues around gender inequality.
Chair: Thank you. Could I direct you back to Chris’s question about women smallholders and what more we could to support them?
Abigail Perry: Yes, so certainly there is a need to ensure that initiatives focus on women’s inclusion and women’s economic empowerment. The UK has had some track record and some investment in this area, but I think it goes back to my earlier comment about tying together some of the more macro-level initiatives around agriculture into thinking about who is benefiting and who is getting those concrete impacts, because the macro-level work is very important but can mean that vulnerable groups or at risk groups, including women, are left behind. There are successful examples of how this can be done.
The World Food Programme with FAO, EFAD and others have been supporting women, not only in terms of strengthening agricultural production, but also looking at how they can better access retailers and the markets, and that is generating positive benefits in terms of increased productivity, increased earnings and, importantly, increased control of resources for women. This is very definitely an area that the UK needs to look at more concertedly, making sure that there is a link between these macro-level commitments and the question of who is going to benefit and which benefits matter, and ensuring those links are made more concretely.
Florian Monnerie: Adding to this, I am in full agreement with Abigail. I would add making sure that nutrition programmes also have sexual and reproductive health components in their health components, particularly for women—that is very important—as well as a mental health component, especially in countries where there are crises or shocks that affect women disproportionately when they are facing nutrition or food security concerns.
Q36 Nigel Mills: Our Foreign Secretary has said that he still believes we are a development superpower. Do you think that is really the case on nutrition issues?
Abigail Perry: I do want to acknowledge the intellectual leadership that the FCDO has continued to show on nutrition on the global stage, including through things like the inclusion of nutrition in the food security summit that was convened towards the end of 2023, is still incredibly important. There is a remarkable deficit of intellectual-thought leadership and clear voices on nutrition on the global stage so the UK’s engagement on that front is welcome. As Florian mentioned earlier, money is not the only valuable part of this.
That said, I do think when it comes to the superpower part of this, it can be extremely difficult to drive forward real change and shifts in policy approaches without there being resource behind them, so I think ultimately the cuts to the ODA budget and the unpredictability that has come through them does make it much harder for the UK to link that intellectual capacity—all the great thought leadership, the evidence and so on—into driving forward concrete change. It is concretely very difficult for organisations like the World Food Programme to take forward innovation strength in what we are doing if we do not have the resources to do it. There is a little bit of money needing to go where the mouth is on this. I do think the UK has fundamentally diminished in that perceived status as an aid superpower.
Nigel Mills: Thank you. Florian, any thoughts? Are we a leader on this issue?
Florian Monnerie: I would go definitely in the same direction as Abigail. The UK remains a key player globally for maintaining the nutrition agenda on the global stage and the latest White Paper does insist on this in the multilateral changes that are needed. But I would definitely say that one key message on nutrition is that remaining an aid superpower may be going back to the 0.7% gross national income percentage from before 2020. That is something that an aid superpower would do.
Q37 Chair: Delicately put.
Florian, one question: not thinking about humanitarian situations, but thinking from a development perspective, if the UK were looking to invest in a nutrition project that was sustainable, what timeframe should you be looking at to achieve a lasting change?
Florian Monnerie: Honestly, three to five years.
Chair: Three to five years? Thank you very much for that.
Thank you both very much for your evidence. It has been very interesting and most informative. We do appreciate your time. Thank you very much for your presence.
Witnesses: Dr Mairo Mandara and Grainne Moloney.
Q38 Chair: Could I ask for panel three to come forward. Dr Mandara, do you want to come in and step into the hot seat and then I think we’ve got Grainne Moloney on the screen. While Dr Mandara settles herself, Grainne can you tell us who you are and who you are representing here today please?
Grainne Moloney: Thank you very much, Madam Chair. I am a senior nutrition adviser with UNICEF, in our headquarters in New York. I lead on our early childhood nutrition agenda. UNICEF, as you all know, is mandated by the UN General Assembly to uphold the UN convention on the rights of the child and promote the right to wellbeing of every child. We work in over 190 countries in both development and humanitarian settings, and we are the global sector cluster lead for nutrition.
In 2023 UNICEF, with partners, reached over 150 million children under five years of age with services for the early detection and treatment of child wasting in high risk settings, including reaching 7.3 million children who received treatment for the most severe form of child wasting. This included 5.6 million children with severe wasting in the 15 countries hardest hit by the global food crisis. Thank you.
Q39 Chair: Did you receive cuts from the UK to your programmes?
Grainne Moloney: Yes. UNICEF and the UK have been great partners in addressing malnutrition in children and women for many, many years, and historically the UK Government have been global leaders. However, the ODA cuts in 2020 diminished the role, resulting in large reductions in spending on nutrition, including those of UNICEF, which had devastating impacts on health and nutrition outcomes for children. The aid cuts had significant impact in some specific country programmes—in Syria, Venezuela, Nigeria and Egypt, among others, funding was significantly reduced.
In 2020, the UK was the main contributor to our response in Syria and it allowed us to conduct nutrition screening of over 2.7 million children and pregnant women. We reached 1.6 million children and pregnant women with micronutrients, and life-saving treatment for nearly 18,000 children. However, a year later, in 2020, our office in Syria was informed that the UK had no plans to fund its programme that year. This funding then threatened our country office and the Government’s ability to continue making progress in tackling malnutrition, which means that fewer children and women are being reached, and it increases their risks to morbidity and mortality in some cases. In Zambia, UK spending on the SUN II programme was cut by about £3.28 million, out of an expected £11.78 million, leading to many projects ending, and scaling back in other areas.
It important to note, as was said by previous panels, that it is not just the funding cuts but the message these cuts give. The UK Government have an important convening role in global nutrition, and it can crowd in and leverage other donors to contribute. When funds reduce, it shows that the UK is walking away from the table, and that message influences other donors, which has a multiplier effect. That is regrettable.
Q40 Chair: The argument we were presented with was that while they stepped away financially, they were encouraging others to fill the gap. Did that happen?
Grainne Moloney: I would say not to the extent that would have been desirable. I think that the initial seed financing in the Child Nutrition Fund has helped. This was a match window that had seed funding from the UK Government. This match window is a catalytic one-to-one matching mechanism that allows national Governments to double their investment in essential services and supplies for the prevention, detection and treatment of child wasting. It can be multiplied through leveraging domestic resources towards child wasting. We received seed funding from the UK Government for that. As a result of the initial mechanism that was launched in 2021, an additional $168 million has been invested by other philanthropies and other donors. That is one mechanism where the UK’s innovation and investing in that seed financing made a difference. But in other areas of investing in programme delivery—no, the gaps remain. As the needs increase around the world, the funding and the ODA we receive is not sufficient.
If I may, in March this year, UNICEF will release a global report that will highlight that as of now, approximately one in four or close to 190 million children globally are suffering from something we call severe child food poverty. For context, children require five out of eight recommended food groups to meet their minimum dietary requirements for healthy growth and development. We measure child food poverty as a child consuming less than five of the recommended eight groups. We say that children receiving less than two of the recommended eight groups are living in severe child food poverty.
Children in severe child food poverty are normally only consuming either breast milk or another dairy product and a cereal. We have millions of these children around the world and the numbers are increasing. Of course, these numbers are increasing because we have a combination of conflict, climate change and the ongoing crisis that is deteriorating every day. We know right now that we have about 27 million children living with wasting in the 21 countries most affected by the global food prices, of which over 7 million are affected by severe wasting. These numbers are astronomical and they are continuing to increase. When we have—
Q41 Chair: Grainne, let me pause you there. We want to come onto stunting and wasting in more detail, but I have not given Dr Mandara a chance to say hello to us yet. Hello, Dr Mandara. I wonder if you could introduce yourself and the organisation you are representing here today. Thank you for coming in person. I know it is not always possible.
Dr Mandara: Thank you very much and thank you for having me in person. My name is Mairo Mandara. I am an obstetrician, gynaecologist, and a public health physician. I am currently based in Abuja and Maiduguri, north-east Nigeria, working in the rebuilding of the Boko Haram ravaged north-east Nigeria. I am also a women and girls activist, which is why I sit on the global council for United Against Hunger and Malnutrition, where we bring in experts from different fields of work like me, politicians, faith-based organisations and people from different sectors to see how we can contribute in repositioning malnutrition as a very important element, not only of global health, but of global development. We also work closely with Members of Parliament and the media to raise the political salience of nutrition.
Q42 Chair: You said that you are working to reposition malnutrition as a global health issue—particularly around politicians and donors, I assume, and also Governments themselves, I imagine. I wonder if you can speak on the specific impacts of malnutrition on women and girls, and what you have been doing to raise awareness of that.
Dr Mandara: Malnutrition, as has been said, severely affects women and children more than anybody. For women and girls, it is something that you could follow through as a vicious circle. If we start with a girl, say, from childhood—boys and girls in childhood require about the same, but as girls move into adolescence, you find natural things like menstruation and growth spurts come in. Although they have lower body mass, girls and women need micronutrients for replenishment of all these natural processes: expansion of the pelvis and the famous hourglass shape of the girl—these are contributions towards adulthood for women. Once there is malnutrition, you find that there is stunting of the girl. There is also anaemia, so much so that as women reach into adulthood, about 40% of women are anaemic, even during pregnancy.
Over 60% of women have deficiencies in micronutrients, which now translates into pre-pregnancy—they are starting on a negative and now they have a foetus, which is more or less like a parasite that must take what it needs. Regardless of what you have, the foetus needs a certain amount of calcium, which it sucks from the mother. That is why in the olden days, when a woman has had several pregnancies, she loses her tooth because the baby takes away the calcium. These are things that you find in women.
It does not stop there. The malnutrition in women moves on. As she gets pregnant, the foetus grows. If it does not have enough micronutrients, there is defect in the development of the brain. There are things like spina bifida and many other significant problems with the foetus, which now come out to the baby. The baby has lower brain function, lethargy, and it becomes a vicious circle. You then have an adult that is not fully developed to take all the responsibilities. If a girl or a woman is malnourished, the impact is not just on her pregnancy and on her child; it is for the whole generation of her lifecycle, and it becomes a vicious cycle forever. This is how significant it is.
Q43 Chair: The previous panel member from World Food Programme said that because of gender inequality women and girls are more likely to face malnutrition anyway. You are putting a strong argument of why, both for the individual and for future generations of women and girls, it is vital that they have the right micronutrients. Do you see donors and programmes recognising the specific needs of women and girls in the help that they deliver?
Dr Mandara: I think that they are trying, but there is a lot that needs to be done. I work as a physician and an activist. From working with women and girls in rural communities, seeing what they are going through, I think that there is a lot that needs to happen. For example, there are lots of interventions going on around nutrition for women and girls. Nutrition for women cannot come without women’s empowerment. Women contribute to more than 50% of subsistence farmers. Increasingly, most of the programme looks at keeping women as subsistence farmers. It needs to be more ambitious. Women need to be empowered enough to move from subsistence to small and medium-scale farmers, from being able not just to survive, but to eat and make decisions.
Q44 Chair: Thinking specifically about the UK, do they target enough to women and girls when it comes to nutrition and malnutrition support? Is it a priority that you are aware of?
Dr Mandara: Considering the funding cut, one would hypothetically expect that the impact of the cut will be significant, but it is difficult to objectively say so because the UK, as of now, does not have indicators that holds itself accountable. There is no number. In 2020, the UK had a target of 50 million women and girls. At the moment, there is no number and there is no disaggregation by gender. Whatever you do, what percentage are women? What percentage are children? There are also no impact indicators that you could follow. By its design, it is not meant to be able to say for certain what the impact is—which is a major setback in the design.
Q45 David Mundell: Grainne, can I ask you about the need to further tackle stunting and wasting? Our evidence indicates that a policy shift will be required if we are to tackle this in children. What further action would you like to see from the UK and FCDO?
Grainne Moloney: Thank you very much. It is important to note first that we have made progress globally with childhood stunting, particularly since 2000. We have reduced it by over a third and we have 55 million fewer children stunted. In fact, we are on track to also achieve one of the World Health Assembly targets—the only one, actually—for exclusive breastfeeding. We are rapidly approaching 50%, which is a big jump from 38% globally in 2012.
All of this is to say that we know what to do, and we have proven in many parts of the world that childhood stunting and childhood wasting is history. It is not that we do not know what to do. We do, but we need to make sure that we continue to fund it, that it is at scale, and that it is with quality and reaching those that need it the most.
If I were to simplify it, I would say that children need three things to grow well. They need nutritious food, they need quality services—they need to be immunised and if they are sick, they need to be treated—and they need healthy practices, which means in the care and food preparation practices. Therefore, with the right Government leadership investing in those three things, we can eliminate childhood stunting and wasting. In fact, we can also tackle the increasing epidemic of childhood overweight and obesity because in many cases the drivers are the same. We need actions to strengthen global and national Governments to activate the food system, the health system and the social protection system, because they are the three most important systems to make childhood malnutrition history, in both development and fragile contexts.
Transforming food systems means how we make sure that the most vulnerable populations can access the nutritious diets they need to grow well. That is for both under-nutrition and over-nutrition. That is through initiatives such as incentivising the production, distribution and retail of nutritious food for young children, including fish, eggs, dairy, poultry, meats, pulses, fruit and vegetables. It means making sure that they are affordable, accessible, and desirable, and it also means that we need to restrict mass production of ultra-processed, unhealthy foods by the food and beverage industry. They are becoming far too affordable and far too prominent. We need to make sure that children and households can access much more affordable, nutritious food.
We also need to leverage our health system to make sure that we have community health and nutrition workers who are equipped and can provide services such as counselling and care practices, who can detect and support the delivery of essential services to screen children for acute malnutrition, can treat children with severe malnutrition, using ready-to-use therapeutic foods, and can provide pregnant women with multiple micronutrient supplements that they need. There are a lot of evidence-based interventions that we can use and many of them can be delivered through the community.
Finally, for the poorest, we need social protection systems that are responsive to the additional needs that certain parts of our population require in order to achieve good nutrition. That is things like cash, food or vouchers, and even the cost of being able to get transport to get to the hospital to deliver their baby—all these types of interventions to make sure that we are being equitable in ensuring that the most in need get what they deserve.
Q46 David Mundell: Yes. I think that you have answered my next question about what needs to be done to tackle under-nutrition and the obesity issue. Do you think that the things you have set out will tackle the obesity problem that has started to develop?
Grainne Moloney: Absolutely. The first 1,000 days are fundamental to a child’s health and nutrition outcomes long term, both for the risks of under-nutrition and over-nutrition. It is the same healthy behaviours that can make a difference between whether or not a child has a risk of becoming overweight and obese in future life, but it also has an impact on their mother. For example, good nutrition through pregnancy, as clearly outlined by the doctor, is fundamental. A well-nourished baby that is born a healthy weight has a much lower chance of becoming overweight in future life. The same goes if we have a well-nourished mother in pregnancy who is able to deliver a healthy baby and then start breastfeeding immediately; she also reduces her child’s future risks of NCDs, and of being overweight and obese.
It is important to make sure that when children are introduced to complementary foods from six months of age, they are introduced to nutritious foods that are locally available and meet their nutrient needs, and that they are not introduced to high sugar, high salt, high fat foods. Taste preferences are established in those first two years of life. We need children to not be used to sugary or salty food, and we need children to drink water. Children should not be given sodas, fruit juice or the types of sweet drinks that then make them not want to drink water. A lot of the practices and behaviours in early childhood can set up a child for a good outcome, and their mother in the long term. It is a lot of the same practices at that stage.
Of course, when children get older and we see rates of obesity and overweight exploding once they go to school, that is where we need to look at the environment in which these children are learning to make sure that the school is not promoting cheap, fast foods or soda, but that children are learning and being exposed to the healthy practices they need to make good decisions about their nutrition.
Building on what the doctor just said, part of that is about giving more visibility to the nutrition of adolescent girls and women. The global community has been failing this particular group and we know that we need to do a lot more. Last year, UNICEF released a report that looked at the nutrition crisis in adolescent girls and women called “Undernourished and Overlooked” because the world is failing this group and there is a lack of progress. One particular statistic that stood out is that half of stunting in children under two develops during pregnancy and in the first six months of life. This 500-day period when a child is fully dependent on their mother’s nutrition shows the strong connection between improving the nutrition of adolescent girls and women, and reducing the burden of stunting and child wasting. You cannot separate these groups from each other.
Unless we invest in the nutrition of our girls and our women, we will not be able to tackle the crisis of wasting and stunting. Particularly in some regions of the world, such as south Asia, if we can eliminate low birth weights in babies because of poor nutrition during pregnancy, we can eliminate wasting in many of countries. We need to get much more deliberate on our investments and our actions on maternal and adolescent malnutrition.
Q47 David Mundell: Thank you. Dr Mandara, as you said in earlier evidence, a woman is often the last person in the household to eat and will eat the least amount of nutritious food. Following on from the points that have just been made, do you think that FCDO is putting a sufficient focus on women and girls in its nutrition programming?
Dr Mandara: I think that the work that FCDO is doing on women and girls in the document is well crafted and is state of the art. But in practice, there are certain things that I think could be improved in the practice of the strategy—for example, consultation with women and girls themselves.
Secondly, the programmes need to look at sustainability from the beginning. The opportunities for sustainability come around supporting country programmes so that all the myriad things that my colleague from UNICEF has said could be put into one document. For example, there is no way we can talk about management of malnutrition without looking at prevention and treatment. Once they support Government policies, having the opportunity to include things such as girls’ education, which in my opinion is a silver bullet, then they will look at it with a different lens. At the moment, FCDO supports a lot of early childhood education, but we know scientifically that the education that impacts life, nutrition, decision making, contraception, and anything actually, is completion of secondary school for a girl. Every girl must complete secondary school to be able to make informed decisions. These are the nuances that the involvement of women and girls would give.
Finally, I will talk about scaling up. I think that there is need for massive scale-up of what works. We know what works. For example, RUTF—ready-to-use therapeutic foods, and MMS or multiple micronutrients supplementation. Those are things that work, but they can only be sustainable if we start having, for example, local production. Local production will make it close to the people and it will cut on costs. That would also ultimately bring the issue of accountability. Once all these things are brought together—working in partnership with the beneficiaries, working in partnership with Governments for sustainability, and having lenses of scaling up of things that work—that would significantly improve how the FCDO addresses nutrition for women and girls.
Q48 David Mundell: How do you think that the ability for women’s and girls’ voices to be heard would be brought about? What is the mechanism or process for doing that?
Dr Mandara: Working with local organisations. Local organisations are on the ground. They work with women and girls. They listen to women and girls. The beauty of it is that the UK Government as a whole has a convening voice. It has a convening power. Even where its funding is not as significant as other countries, because of historic reasons of trust, predictability and being there for ages, it has convening power. It has to bring in local organisations that work with women and girls into the nutrition circle so that they are able to speak for themselves and they are able to say it the way that they see it themselves. That is empowering for women and girls.
Q49 Chris Law: I am reflecting on what you said there. I am aware of the partnership between Scotland, Malawi and the Mary’s Meals programme, where they serve 1 million meals per day in schools for young children—the nutritional programme. It is quite cost-effective. Would you like to see that rolled out more broadly in places other than Malawi, and also with much greater support from UK Government?
Dr Mandara: That is a very good initiative of in-school feeding. However, while it is important, we need to look at it within the context of who is supplying the food. We are giving children food. What happens when that grant ends after three years? We need to empower the communities and the women’s groups to be the suppliers of the food. That way, even when funding goes, it is not difficult for them not to feed their own children. I think that is a beautiful strategy and is the nuance of sustainability. We just need to improve on it and it will be good to go.
Q50 Chair: Dr Mandara, I like what you are selling. Talk to me more about sustainability. I know that here in the UK, we have disregarded our farmers for a long time and we have become very reliant on imported food. When I go to many places around the world, the amount of food they import is shocking. Not only is it economically expensive, but it also makes them vulnerable. Do you see enough investment in micro-farms and smallholder initiatives, and in teaching women particularly how to grow their own food and support their own families that way, or is the emphasis from funders and donors more on giving food rather than sustainability?
Dr Mandara: That is an interesting question. I now work in that space in north-east Nigeria in Borno, in the humanitarian setting, where we have all the groups you have brought—UNICEF, WFP, Action Against Hunger. Initially, they were giving food to communities, especially in the humanitarian setting. As we got a bit more peace, we asked them to give food vouchers so that people can choose what food to buy. You do not give me rice every day; you give me a voucher to decide whether I want to eat rice, bread or whatever. Finally, we are now moving to a stage where WFP is working more to supply farmers with impute so that they are able to move. I think that needs to happen more and more. If it happens in a humanitarian setting, the impact will be worse in the development setting. Even in the humanitarian setting, we have people living in IDP camps for the last 10 years, and people are given food rations. Children brought up in that see their parents queue up for food rations for 10 years, so they do not know the value of hard work or earning. It was a hard task to shift some of our partners to see that it is not good in the long run.
Chair: It creates dependency.
Dr Mandara: And it is pretty expensive. Once you are able to give people choice—even if you give, say, a voucher of £10 instead of rice worth £10, and the person decides to buy rice worth £10—at the minimum you are creating human interaction and you are moving money around. You are asking people to negotiate. You are giving them the value of being human beings, not just being fed. Some of these nuances can only happen when big donors interact with locals at the concept level, not when the strategy has been made and then we try to find ways of implementation. Then it becomes the reverse.
Q51 Chair: You were talking about local production, and the first panel talked about the impact of climate change and how quickly it is changing what can and cannot grow. An example they gave was that they would have to import a seed that has a shorter growing time to meet the shorter seasons, for example. Normally, farmers keep back some of their own grain to plant the next year, so to import this new strain requires them to have a financial investment. Do you see from the donors that insight about the long-term investment? If you give the farmers the seed that they can use for future generations, that creates a sustainable system rather than a dependent system.
Dr Mandara: I think that is a great way. When I worked at the Bill & Melinda Gates Foundation, that was tried with Noiler chicken, a breed of chicken whose production of meat and eggs is higher than that of free-range, but not as much as those caged, yet they have higher immunity, so they do not die as those caged. Bringing in the first cohort, but empowering the farmers to continue to produce that, is great.
Especially now with climate vulnerability, that is more crucial than before. For example, I work around Lake Chad. Lake Chad has shrunk to almost 10% of its size. It used to give employment for about 4 million people, now less than 1 million people—about 250,000 to 500,000—stay there. Those are the kinds of things that breed Boko Haram: the poverty and the lack of education. It is such a big vicious circle.
Yes, it would work, but put it together with ability to produce in future.
Q52 Chair: Grainne, could I ask, either specifically from a UNICEF point of view or looking at FCDO funding more generally, if you see the funding going to the outcome—that being, “someone is hungry so let’s feed them”—or do you see it going into the longer-term preventive, creating a sustainable agricultural system?
Grainne Moloney: From the nutrition perspective, I would say both. I can speak from my own personal experience when we had a DfID grant, as it was known then, in Kenya over many years. That grant directly supported the Government and was to invest in longer-term system-building to reduce malnutrition and to build the capacity of the Government to withstand future shocks. Particularly in northern Kenya, shocks are very common. It was so inspiring that that funding helped crowd in funding. We got the Government to invest in domestic leveraging, but we saw dramatic reductions in childhood stunting. This investment over 10 years does work.
Development takes time. It will not be resolved overnight. We have so many examples in many countries where decent amounts of funding from the UK Government, working in partnership with the Government, local communities, partners like UNICEF and other agencies can make a difference. We see results. I think that we need to get better at telling that story so the public are aware that their money is getting results, and that communities and Governments are doing better.
Another example is the child nutrition match fund for RUTF that I mentioned earlier, where the UK Government was the seed funding that allowed this to happen. As a result, now the Government in Mauritania is buying 100% of its own RUTF. In the first year, they bought 25% and was matched 75% through the fund. The next year, it was 50%, and the following year 100%. Over time, it is about being clever with the investment, recognising its potential and crowding in other donors where it makes sense. Ultimately, that leads to bringing down child malnutrition, improving child survival and improving women’s nutrition. There are many solid examples. Of course, since the cut in the ODA and the deteriorating global situation, the risks to undermine all of those gains are acute. The sooner that the UK Government can come back to the table in a serious way and recommit to 0.7%, the better for the world, frankly.
Dr Mandara: I also think that it is important in the funding cycle to look simultaneously at the short term, medium term, and long term—the short term addressing the needs now, the medium term addressing the issues of prevention and so on, and the longer term sustainability. All three have to be together.
Secondly, I think that accountability is also important, looking more closely at what percentage of the fund goes to the beneficiaries and what percentage stays in administration. It is easy to overlook that. Because I work now in a humanitarian setting, I am able to see that in some cases as much as 70% goes to administration and only 30% goes to the beneficiaries. In development, it is not as high because of the other benefits. Look closely at those, because some of the answers would be found there, so that every pound is maximised. The output—what is the unit? A pound for what? How is that pound spent? Disaggregate it.
Q53 Chris Law: Thank you. Dr Mandara, how can FCDO empower women, particularly smallholder farmers, to meet the needs of their community?
Dr Mandara: I believe that FCDO can support smallholder farmers, first, by supporting research to understand what women smallholder farmers need. That is important. Secondly, it could be bolder. What I have seen across Africa is that when you have smallholder farmers, you support them to continue to be happy smallholder farmers with no big ambitions. We need to support them, especially women, to have more ambition, to be able to move from here to here—value chain addition in their product. Also, importantly, it should support systems and mechanisms that make it easy for smallholder farmers to get loans and access to finances. It is extremely difficult, particularly for women, when they form over 50% of the smallholder farmers, yet land ownership is between 5% and 10% at most. They are totally disadvantaged unless there is a deliberate effort to make sure that they have access to farmland and to financial systems. I think that FCDO has the ability to be able to influence some of those financial systems that make equity a big issue in nutrition.
Q54 David Mundell: On the basis of your evidence, Dr Mandara, I think that you have presented the difficulties, but you have also presented that there are positive opportunities to make a change, and therefore there is hope out there that the situation can be turned around. Is that your general mindset, if I can put it that way?
Dr Mandara: Absolutely. There are big opportunities, particularly around women and girls, and linking nutrition with empowering women. I do not know sometimes if the UK understands its own convening power. The UK has a big convening power. Use that convening power to make sure that it brings in all the actors to do that, but in the process, show transparency and accountability to be able to bring others across. There is big opportunity, but the right level of funding for the right mix is crucial. Scaling up proven interventions that are easy and sometimes the difference between life and death for a child, like RUTF, is important.
Chair: Thank you both very much. We appreciate all the evidence that you have given us, and the work that you and your organisations both do. It has been a fascinating session for me. In an opening session, you have given us loads of notes and directions for our inquiry to go in. Please feel free to write in if there is more. Grainne, I believe you have a long list of projects that were cut, and the number of children and women that were impacted. If could write in with those, it would be helpful to give us better oversight of the actual lives impacted rather than just the numbers—as I think those can be easy to diminish. Thank you both very much.